Background Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? Purpose/Objectives The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. Design An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. Procedures A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). Results Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. Conclusions Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

Nurse practitioners practicing in specialist palliative care roles in communities and hospitals have embraced the use of POST and followed through on complete and accurate completion of the forms. With this signatory authority, primary and specialist NPs have the potential to improve end-of-life care.

Federal, state, and educational policy, as well as public and professional initiatives, should influence how care is delivered to veterans from non-Veteran Health Administration (VHA) advanced practice registered nurses (APRNs) located in civilian health care facilities. Due to the MISSION Act, more veterans are receiving care outside the VHA, but little is known about the readiness of APRNs to address the needs of this population. This mixed-methods study describes the perceptions of 340 non-VHA APRNs concerning practice, clinical needs, and challenges they face while delivering care to veterans. Survey results show only 8% of APRNs consistently asked about military service; less than 1% asked if the patient has a family member with military history; and only 25% applied research by inquiring into military history when patients presented with conditions like chronic pain, interpersonal violence, or insomnia. Technology use via mobile application was minimally reported (<1%). “Missing in Action,” the overarching theme from qualitative data, included three subthemes: (a) absence facilitated collaboration with VHA, (b) concerns regarding personal competency in the care of the military person, and (c) lack of recognition of the significance of the need to know about military status. Practice implications proffered include implementation of mandatory inquiry into military service and enactment of APRN veteran-centric nursing competencies. Education actions involve updating graduate nursing programs to include veteran health content and increased policy awareness. Future research should encompass replication of this study in specific APRN roles and consist of ongoing evaluation of veteran care by the civilian sector as the MISSION Act is implemented.

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Historically nurses have been strongly engaged in the political process, however in recent decades the profession has moved away from the policy arena. Without political engagement, issues that are important to the nursing profession are not addressed timely, if at all. One such issue is that of full practice authority for advanced practice registered nurses (APRNs). Well over 100 studies have been completed over the past 40 years showing the safe and quality care APRNs provide independently. Numerous well-respected, non-nursing organizations support the removal of state laws that impede the ability of APRNs to practice to the full extent of their education and training, particularly in light of the looming extinction of primary care physicians and the simultaneous increase in demand for primary care services (American Association of Retired People, 2011; Federal Trade Commission, 2012; Institute of Medicine, 2010; National Governor's Association, 2012). The purpose of this capstone project was to provide a website in which APRNs and APRN students could communicate quality information to legislators in support of full practice for APRNs in West Virginia during a legislative session in which a full practice bill was introduced. Website visitors who were APRNs or APRN students were asked to complete a survey on the website comparing their communication with legislators last year to their communication or intended communication, after they had been introduced to the website, during the current session. Findings included a strong statistical association between use of the website and communication with legislators along with a statistical association between use of the website and conveyance of quality information supporting full practice authority. The findings suggest that websites related to specific nursing issues could be a method to increase political involvement of nurses.